Clostridium difficile

Abstract

Clostridium difficile is the leading cause of healthcare-associated infectious diarrhea. Although C difficile is part of normal flora in some healthy individuals, patients with selective risk factors are often vulnerable to the toxigenic potential of this virulent healthcare pathogen. The spectrum of C difficile infection (CDI) is highly variable, ranging from mild to severe illness, presenting with single to multiple disease recurrences. Current approaches to treatment are based on severity of illness, number of recurrences, and clinical presentation. Oral vancomycin and metronidazole have formed the foundation for treatment of CDI, but therapeutic failures are commonly reported, especially involving hypervirulent clones. Alternative therapies, including newer antimicrobials, probiotics, immunotherapy, and fecal transplantation, have all met with varying degrees of efficacy. Although toxigenic culture (TC) testing from anaerobic culture remains the gold standard, newer technologies, including enzyme immunoassay, common antigen (glutamate dehydrogenase) testing, and real-time polymerase chain reaction (PCR) are less time-consuming and rapid. However, TC and PCR have reported high specificity and sensitivity when compared with other laboratory tests. Because of the significant morbidity and mortality associated with CDI, a high index of suspicion is warranted. Prevention and eradication of CDI require a multidisciplinary approach, including early disease recognition through appropriate surveillance, implementation of effective contact isolation strategies, adherence to environmental controls, judicious hand hygiene, evidence-based treatment, and management that includes antibiotic stewardship, continuous education of healthcare workers, and administrative support.

Identification of a Novel Lipoprotein Regulator of Clostridium difficile Spore Germination

“…C . difficile infections have primarily been associated with individuals undergoing antibiotic therapy, but long hospitalizations, underlying comorbidities, community-acquired infections, and age-related risk factors have also been documented [ 4 – 6 ]. These complications lead to C .…”

In VitroSelection of a Single-Stranded DNA Molecular Recognition Element againstClostridium difficileToxin B and Sensitive Detection in Human Fecal Matter

“…Currently, diagnostic tests for CDI are stool culturing, cell cytotoxicity neutralization assay, enzyme immunoassay (EIA) for toxins A and B, detection of C. difficile glutamate dehydrogenase (GDH), and polymerase chain reaction (PCR) detection of C. difficile genes [ 10 ]. Culturing diagnosis is very sensitive, but the turnaround time can be up to 3–5 days [ 11 ]. GDH testing is very sensitive but is not specific and requires additional EIA for toxin A and/or toxin B [ 11 , 12 ].…”

“…Culturing diagnosis is very sensitive, but the turnaround time can be up to 3–5 days [ 11 ]. GDH testing is very sensitive but is not specific and requires additional EIA for toxin A and/or toxin B [ 11 , 12 ]. There are multiple commercial EIA kits for toxin A/B detection on the market, but their sensitivities vary and they may not be available in all countries [ 13 ].…”

“…There are multiple commercial EIA kits for toxin A/B detection on the market, but their sensitivities vary and they may not be available in all countries [ 13 ]. PCR test has a rapid turnaround with good sensitivity and specificity but does not detect the presence of virulence factors and the cost associated with the test may limit its usage [ 11 , 14 ]. A confirmed diagnosis of CDI usually requires positive results from two or three of the available tests [ 15 , 16 ].…”

Multicenter Evaluation of the Quidel Lyra Direct C. difficile Nucleic Acid Amplification Assay

“…The increased economic burden in hospitalized patients due to CDI has been estimated at $9,822 to $13,854 per patient, and total patient costs (health care costs plus lost wages) associated with CDI have been estimated to exceed $1 billion annually in the United States alone (3,4). Several recent studies have demonstrated that rapid and accurate detection of C. difficile is an important component of combating hospital-acquired CDI and can have a significant benefit to patients and hospitals from a financial and clinical perspective (4)(5)(6).…”